Individual provider Active NPI

Cosheonna Simmons, LCSW-A

  • Clinical Social Worker
  • Fayetteville, NC
National Provider Identifier
1639878028
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
3505 Village Dr Ste 101
Fayetteville, NC 28304-4514
Phone
(910) 500-1800
NPI assigned
Feb 24, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

3505 Village Dr Ste 101
Fayetteville, NC 28304-4514

Mailing address

3505 Village Dr Ste 101
Fayetteville, NC 28304-4514
Phone (910) 500-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260504006476 NC Practitioner - Clinical Social Worker 3072957455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1921 Ransom PL
Nashville, TN 37217-3841

9565 - 189 Cliffdale Rd
Fayetteville, NC 28304-5956

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone of Tennesse Inc. CurrentSince Apr 13, 2026 Accepting new patients
Centerstone of Tennessee, Inc. PastSince Apr 13, 2026 Accepting new patients

Locations

3505 Village Dr
Ste 101
Fayetteville, NC 28304
Phone (615) 463-6669

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1639878028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 VILLAGE DR STE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044514",
            "telephone_number": "910-500-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 VILLAGE DR STE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044514",
            "telephone_number": "910-500-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "COSHEONNA",
        "credential": "LCSW-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-24",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.